JAMDA
Volume 8, Issue 2 , Pages 115-122, February 2007

A Multivariate Fall Risk Assessment Model for VHA Nursing Homes Using the Minimum Data Set

  • Dustin D. French, PhD

      Affiliations

    • VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC, Tampa, FL
    • D.D.F. took the lead in preparing and analyzing all data. He prepared the draft manuscript after consultation with the co-authors who assisted in the study design, literature review, and manuscript preparation. D.D.F. was responsible for the final draft submitted.
    • Corresponding Author InformationAddress correspondence to Dustin D. French, PhD, VISN-8 Patient Safety Center of Inquiry, 13000 Bruce B. Downs Boulevard (118M), Tampa, FL 33612.
    • ,
  • Dennis C. Werner, MHA

      Affiliations

    • VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC, Tampa, FL
    • D.C.W. took the lead in obtaining the National MDS data and assisted D.D.F. with the Material and Methods and the Results sections.
    • ,
  • Robert R. Campbell, JD, MPH, PhD

      Affiliations

    • VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC, Tampa, FL
    • R.R.C. assisted in conceptual layout of paper, interpretation of data, literature review, discussion, and patient-safety implications.
    • ,
  • Gail M. Powell-Cope, PhD, ARNP, FAAN

      Affiliations

    • VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC, Tampa, FL
    • G.M.P-C. assisted with the introduction and provided clinical expertise for the variables analyzed.
    • ,
  • Audrey L. Nelson, PhD, RN, FAAN

      Affiliations

    • VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC, Tampa, FL
    • A.L.N. provided clinical expertise in the area of patient safety, nursing homes, and falls in the elderly, and reviewed drafts of the manuscript.
    • ,
  • Laurence Z. Rubenstein, MD, MPH

      Affiliations

    • UCLA David Geffen School of Medicine and VA Greater Los Angeles Healthcare System (GLAHS), Geriatric Research, Education and Clinical Center GRECC), Sepulveda and West Los Angeles Divisions, North Hills, CA
    • L.Z.R. provided a clinician’s perspective as a leading expert in the area of falls in nursing homes. He served as a reviewer of the final manuscript to ensure clinical relevance.
    • ,
  • Tatjana Bulat, MD

      Affiliations

    • VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC, Tampa, FL
    • T.B. provided a clinician’s perspective to ensure that the study’s results provided practical guidance on fall risk. T.B. also contributed to the discussion and limitations sections of the article.
    • ,
  • Andrea M. Spehar, DVM, MPH, JD

      Affiliations

    • VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC, Tampa, FL
    • University of South Florida College of Public Health, Tampa, FL.
    • A.M.S. assisted in conceptual layout of paper, interpretation of data, literature review, discussion, and patient-safety implications, provided editorial review and perspective of James A. Haley VA Hospital Fall Prevention Committee.

published online 30 October 2006.

Objectives

The purpose of this study was to develop a multivariate fall risk assessment model beyond the current fall Resident Assessment Protocol (RAP) triggers for nursing home residents using the Minimum Data Set (MDS).

Design

Retrospective, clustered secondary data analysis. Setting: National Veterans Health Administration (VHA) long-term care nursing homes (N = 136).

Participants

The study population consisted of 6577 national VHA nursing home residents who had an annual assessment during FY 2005, identified from the MDS, as well as an earlier annual or admission assessment within a 1-year look-back period.

Measurement

A dichotomous multivariate model of nursing home residents coded with a fall on selected fall risk characteristics from the MDS, estimated with general estimation equations (GEE).

Results

There were 17 170 assessments corresponding to 6577 long-term care nursing home residents. The increased odds ratio (OR) of being classified as a faller relative to the omitted “dependent” category of activities of daily living (ADL) ranged from OR = 1.35 for “limited” ADL category up to OR = 1.57 for “extensive-2” ADL (P < .0001). Unsteady gait more than doubles the odds of being a faller (OR = 2.63, P < .0001). The use of assistive devices such as canes, walkers, or crutches, or the use of wheelchairs increases the odds of being a faller (OR = 1.17, P < .0005) or (OR = 1.19, P < .0002), respectively. Foot problems may also increase the odds of being a faller (OR = 1.26, P < .0016). Alzheimer’s or other dementias also increase the odds of being classified as a faller (OR = 1.18, P < .0219) or (OR=1.22, P < .0001), respectively. In addition, anger (OR = 1.19, P < .0065); wandering (OR = 1.53, P < .0001); or use of antipsychotic medications (OR = 1.15, P < .0039), antianxiety medications (OR = 1.13, P < .0323), or antidepressant medications (OR = 1.39, P < .0001) was also associated with the odds of being a faller.

Conclusions

This national study in one of the largest managed healthcare systems in the United States has empirically confirmed the relative importance of certain risk factors for falls in long-term care settings. The model incorporated an ADL index and adjusted for case mix by including only long-term care nursing home residents. The study offers clinicians practical estimates by combining multiple univariate MDS elements in an empirically based, multivariate fall risk assessment model.

Keywords: Accidental falls, falls, patient safety, nursing homes, long-term care, minimum data set, risk factors, risk assessment, multivariate analysis, veterans

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration (VHA). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.This research was supported by the VISN 8 Patient Safety Center of Inquiry, VA Greater Los Angeles Healthcare System (GLAHS), Geriatric Research, Education and Clinical Center (GRECC), Sepulveda and West Los Angeles Divisions, and James A. Haley VA Hospital.No conflict of interest declared.

PII: S1525-8610(06)00414-2

doi:10.1016/j.jamda.2006.08.005

JAMDA
Volume 8, Issue 2 , Pages 115-122, February 2007

Article Tools